Reiki, cancer, and the problem of informed consent

Reiki is a complementary therapy in which a therapist’s hands are placed on — or simply near — a patient’s body, with the intention of redirecting what are purported to be vital energy flows in order to enhance the patient’s physical health and well-being. The main problem with Reiki is that no evidence for the existence of such energy flows has ever been found, rendering claims that therapists can redirect them using their hands (without even touching the patient) immediately implausible. Unsurprisingly, the evidence for any medicinal effect for Reiki is sorely lacking. In reality, Reiki involves a lot of lying down, relaxation, and nice interactions with a Reiki practitioner, and as such has acquired a reputation for making people feel pleasant (as would any regime of rest, relaxation, and gentle social interaction). So what’s the problem? Well, the problem is that proponents also claim that Reiki should have a role in cancer treatment. Yes, cancer treatment.

Earlier this week, the Wall Street Journal carried an article describing the use of Reiki in patients whose cancers make it difficult for them to withstand full-blown massage or physical manipulations (thank you to @a_byrne_ for tweeting the article to me). While the WSJ journalist is careful to raise some questions about the validity of Reiki, the article nonetheless presents many dubious points in a relatively uncritical manner. The overall effect is to somewhat legitimize the provision of bogus treatments to cancer patients, the main beneficiaries of which will be the Reiki practitioners themselves. Because Reiki is not typically covered by insurance, the overall impact of the WSJ article is to invite patients undergoing chemotherapy to consider paying a weekly $110 out of their own pockets for Reiki treatment.

To put it mildly, Reiki is a generally discredited therapy, which among other features is based on a cult-like pyramidal training model, where trainees are urged to become attuned to their own spirituality and to pay heavily for access to credentials. While (as always) individual research studies claiming medical benefits exist, reviews of the empirical research literature as a whole have repeatedly concluded that there is simply no evidence for its usefulness for any medical purpose. In general, the studies showing ‘effects’ are methodologically flawed in failing to include placebo conditions or to control for the general benefits of relaxation.

Now, it is reasonable to point out that consumers are free to indulge themselves with whatever faddish or fashionable pseudotherapy they wish. However, given the stress and turmoil associated with having to undergo serious cancer treatment (during which patients can feel cognitively over-burdened, physically exhausted, and intimidated by their own mortality), the provision and marketing of Reiki to cancer patients could be said to be exploitative, if not indeed unethical. For one thing, when obtaining informed consent (an ethical requirement for any therapeutic intervention), do Reiki practitioners really inform their patients about Reiki? For example, do they inform patients that the cumulative research literature shows no treatment efficacy for Reiki with regard to any medical condition? Do they inform patients that the claim that vital energy can be redirected through a person’s body in a way that promotes well-being (or that such energy even exists) is made without any foundation whatsoever? If Reiki practitioners fail to mention such points then it is very questionable whether ‘informed’ consent can be said to have been obtainedat all. Failing to obtain informed consent prior to treatment is simply unethical.

In all probability, Reiki practitioners will attempt to excuse themselves from the obligation to obtain informed consent on the basis of disagreeing with the established medical literature (however, even if practitioners disagree with the findings of the medical literature, they are still strictly obliged to inform patients of the findings in order to meet the requirements of informed consent). In justifying their disagreements with medical science, complementary therapists typically employ three rhetorical strategies. All three make an appearance in the WSJ article.

The first strategy is to imply that the deficiency lies not with the therapy being scrutinized, but with the empirical researchapproaches currently being used to scrutinize it. Usually it is argued that supportive evidence will eventually be found if methods are improved over time. In the WSJ article, this strategy is apparent in the statement of Professor Lorenzo Cohen, who is quoted as saying, “There isn’t a good evidence base for its utility in cancer care as of yet” (italics added by me). As this implies that a good evidence base will exist in the future, Professor Cohen is effectively asserting that Reiki does in fact work. (In fairness to Professor Cohen, whether he is making this subtle point intentionally or whether he is just falling into the trap of doing so by seeking to be diplomatic is not altogether clear).

The second strategy is toimply that the processes underlying the therapy are so mysterious as to defy ordinary methods of research. The WSJ article gives us an example when it quotes the manager of services at Norris Cotton Cancer Center as saying, “How it [Reiki] works is a mystery” (again, my italics). Note that this type of statement simply ignores the fact that research has shown Reiki doesn’t work.

The third, rather breathtaking, strategy is to ‘interpret’ unsupportive research results as being supportive. The WSJ offers an example of this with its discussion of a research paper published in the academic journal Cancer. The original journal paper describes a study in which 54 men were randomly assigned to complementary therapy (either Reiki or relaxation) or control conditions during prostate cancer radiotherapy treatment. Despite tracking a wide range of indices of psychological functioning using standardized diagnostic instruments, this study showed no significant difference in mental health occurred as a result of the complementary therapies either during or after a 12-week treatment period. In fact, the only apparent statistical effects related to self-reported emotional well-being (i.e., relaxation) scores, which were marginally elevated in some of the patients who underwent relaxation therapy. Importantly, this effect was not seen in patients who underwent Reiki. Nonetheless, despite the fact that the cited study found Reiki to be ineffective in enhancing mental well-being, the WSJ quotes one of the study authors as saying “The evidence for Reiki is still slim, but there are trends” (once more, my italics). Erm, no there aren’t…

Credibly, the WSJ journalist offers substantial caveats when describing two further studies. One was a 2007 study which the journalist notes may have been confounded by nonspecific treatment effects. In other words, the study lacked even a basic placebo condition, which means that its reported finding (a statistically minimal reduction in self-reported fatigue) cannot be attributed to Reiki at all. The other research was a 2004 massage study, which the journalist notes did not include a control condition. However, perhaps the more pertinent omission of that particular study was that it didn’t even include a Reiki condition (in fact, the word “Reiki” appears nowhere in the paper).

Overall, these three rhetorical strategies may help Reiki practitioners to convince themselves that informed consent is not obligatory in their case. However, convincing themselves is insufficient. Cancer patients should be informed of the extensive research literature on Reiki before consenting to treatment. They should also be informed of the fantastical nature of the energy concepts that practitioners use to explain Reiki. While treatments that facilitate relaxation may help patients to cope with the rigours of chemotherapy and radiotherapy, patients do not need to have their intelligence insulted in the process. Also, they don’t need to be paying good money for such benefits.

While the WSJ reporter clearly seeks to achieve balance in her discussion of the research evidence for Reiki, it is perhaps the ethical dimensions of this therapy that warrant greater journalistic scrutiny.

1 reply

One of the best ethical CAM dissections I’ve come across lately, and I do fully agree with the concluding point. Sadly, journalism is not big on sufficiently exploring in-depth ethical issues… in any matter.